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MAY 13, 2016
STATE OF ENROLLMENT CONFERENCE
ALEXIS GUILD, FARMWORKER JUSTICEJAN MORRILL, MAINE MIGRANT HEALTH PROGRAMMELISSA TORRES, GREENE COUNTY HEALTH CARE
Lessons Learned Enrolling Our Nation’s Farmworkers: Strategies to Educate and Enroll Hard-to-Reach Populations
Agenda
Introductions
Who are farmworkers
Overview of farmworker enrollment
Panel discussion
Resources/Key Takeaways
Conclusion
Farmworker Justice
Farmworker Justice is a national farmworker advocacy organization in Washington, DC that seeks to empower farmworkers and their families to improve their working conditions, immigration status, health, occupational safety, and access to justice.
www.farmworkerjustice.org
Maine Migrant Health Program
The Maine Migrant Health Program is our state’s only Federally Qualified Health Center dedicated to providing care and services to farmworkers.
MMHP’s mobile medical units bring primary care to farms across the state. We also provide outreach and enrollment, care coordination, interpretation, and health education services.
www.mainemigrant.org
Greene County Health Care
Greene County Health Care, Inc. is a federally qualified health center that has been providing primary health care in eastern North Carolina for 40 years. We currently operate:
Five primary medical sites Two dental sites One school based health clinic Outreach and Enrollment program Farmworker services program servicing over 15 counties
1. National Agricultural Workers Survey (NAWS) 2011 - 2012. 2. Kandel W. Profile of Hired Farmworkers, A 2008 Update. Economic Research Service, US Department of Agriculture; Washington, DC; 2008. Economic Research Report No. 60. * Note: Kandel uses a combination of NAWS and others data. 3. Martin P. Immigration reform: implications for agriculture University of California, Giannini Foundation. Agricultural and Resource Economics Update. 2006;9(4).
Who are farmworkers?
52,000children who work in
agriculture
Who are farmworkers?
4. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 edition, Agricultural Workers. http://www.bls.gov/ooh/farming-fishing-and-forestry/agricultural-workers.htm)
Who are farmworkers?
Average 2012 individual agricultural worker income: $18,910 4
25% of agricultural worker families had total family incomes below 100% of the Federal Poverty Level
Increasing number of H-2A workers
More males traveling alone
More established in rural communities as seasonal workers
Less trans-border crossing
Engaged in other industries during the off season (construction, meat processing, dairy and others)
Increasing number of indigenous agricultural workers
Less available housing (more dispersion of population)
Changing demographics
Source: Passel, 2006
Farmworker health risks
Work-related Heat stress Falls from ladders Musculoskeletal injuries Pesticides
Chronic conditions Diabetes Hypertension Asthma
Housing Gastrointestinal diseases Lead poisoning Urinary tract infections
Mental health Anxiety/stress Depression Substance abuse Domestic violence
Overview of farmworker enrollment – U.S.
Impact of ACA on uninsurance rate in farmworker communities is unclear Most recently released NAWS data from 2012
34% of workers have health insurance Next set of released NAWS data should provide a clearer idea but won’t provide the
full picture. Why? Represents less than 1% of total workforce Interviews workers at their workplace where employers grant access H-2A workers are not included in NAWS
Vast majority of eligible farmworkers qualify for subsidies, including cost-sharing reductions Nationally, during Open Enrollment 2015, 87% of consumers qualified for the APTC
Farmworkers are enrolling but barriers to enrollment are more pronounced in farmworker communities
Questions about employer-provided health insurance
Overview of farmworker enrollment – U.S.
Opinion about impact of ACA in farmworker communities is mixed
It’s hard to pay the premium when there are other bills to pay at the end of the month
- Worker, Maryland
Many workers have health insurance to avoid the penalty but don’t use it because it is too expensive. Many doctors don’t accept the insurance.
- Promotora, California
There are still people in the community who don’t get the help they need. But there are others who finally have the opportunity to have health insurance who wouldn’t havehad health insurance before.
- Promotora, Arizona
Some workers have been able to get health insurance, but many documented workers are established in other states and so have trouble using their health insurance here.
- Community Organization, New Jersey
Overview of farmworker enrollment - Maine
Maine Migrant and Seasonal Farm Worker Demographic SurveyMaine Department of Labor. 2015
Overview of farmworker enrollment - Maine
• 6 CACs covering the entire state• In person assistance in English, Spanish,
and Haitian Creole• Completely mobile enrollment services• Specialized training in Marketplace and
Medicaid eligibility for immigrants
Overview of farmworker enrollment – North Carolina
H-2A workers start arriving late March and leave the state as late as the end of November. Most of them will stay an average of 7 months.
Crops in Eastern North Carolina include: Tobacco Sweet potato Cucumber Strawberries Cotton Others
Overview of farmworker enrollment – North Carolina
Farmworker (H-2A) origin Mexico Haiti (very few)
Income of farmworkers serviced by the O&E program (GCHC) 11,000 to 27,000 Average of 16,000
Ages of farmworkers serviced by the O&E program (GCHC) 18-63 Average 34
Overview of farmworker enrollment – North Carolina
Job related health concerns in our area: Tobacco poisoning Heat strokes Accidents (pesticides, vehicle, etc.)
Non job related health concerns: Diabetes Hypertension Allergies/ Asthma STD’s
Panel discussion
What are the major challenges working with farmworkers, generally?
Panel discussion
What are the major challenges educating and enrolling farmworkers in health insurance?
Panel discussion
What strategies have been successful for:OutreachEnrollmentHealth insurance literacy
Panel discussion
What changes have you made in O&E since 2014?
Looking ahead to the summer and OE4, what changes (if any) do you anticipate?
Panel discussion
How has your experience enrolling farmworkers helped you enroll other hard-to-reach populations?
Open discussion
Key takeaways
Important to use non-traditional outreach strategies Creativity and flexibility are key!
You need to be flexible and persistent
Always evaluate your O&E strategy and tweak as needed Strategy should reflect the needs and realities of the population
being served
O&E does not end with enrollment
Resources - Maine
Resources – North Carolina
Legal Aid NC- Farmworker Unit— ACA Resources for Farmworker Outreach http://www.farmworkerlanc.org/es/publicaciones/ley-del-cuidado-de-la-salud
NC Justice Center—H2A Workers, Taxes, and the Affordable Care Act http://www.ncjustice.org/sites/default/files/H-2A%20workers%20and%20taxes%20and%20ACA_FINAL.pdf
NC Farmworkers Project Enrollment Booklethttp://www.farmworkerlanc.org/es/wp-content/uploads/2015/08/Color-Shareable-ACA-Booklet-4_18_16.pdf
Resources – Farmworker Justice
Guide to the Health Insurance Requirement (English) (Spanish) (Creole)
Guide for H-2A Workers (English) (Spanish) (Creole)
Guide for U.S. Citizen & Qualified Immigrant Farmworkers and their Families (English) (Spanish) (Creole)
Guide for Lawfully Present Farmworkers & their Families (English) (Spanish) (Creole)
Guide on Employer-Provided Health Insurance (English) (Spanish) (Creole)
FAQ: H-2A Workers and the Affordable Care Act
FAQ: Taxes, Farmworkers, and the Affordable Care Act
Medical-Legal Partnership Guide
Thank you!
Alexis Guild, Farmworker [email protected]
Jan Morrill, Maine Migrant Health [email protected]
Melissa Torres, Greene County Health [email protected]
